By influencing the standards of diabetes care and treatment guidelines throughout the world, the results of recent long-term risk factor interventions in Type 2 diabetes (T2D) have likely contributed to the improved health outcomes and induced a decline in mortality in people with T2D. Although we have a need for even more evidence to support early, individualized, and intensive management of all known modifiable risk factors, we have now reached an era in T2D care where the critical challenges appear to be to translate the insights, knowledge and benefits to patients in the community setting. Current surveys show slow progress in achieving treatment goals and in the use of recommended drugs and adjustments of lifestyle for the prevention of vascular complications in diabetes. The resistance and barriers among medical professionals and patients likely have multiple causes. The present review focuses on experiences from multifactorial interventions in high-risk patients with T2D where it is possible to markedly improve their prognosis.